A Case Study on

Cardiovascular
Disease
(Recurrent Stroke)
 INTRODUCTION

Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of

death and a leading cause of disability in the United States. A stroke occurs when a blood vessel

that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures).

When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain

cells die.

There are two major types of strokes:

a. Ischemic stroke: This is the most common stroke and happens when a blood clot or the

narrowing of a blood vessel (artery) reduces blood flow to the brain. This keeps blood

from flowing into other parts of the brain and stops oxygen and nutrients from reaching

brain cells. Ischemic strokes are commonly caused by:

 Thrombosis: a clot that forms in a blood vessel of the brain or neck

 Embolism: a clot that moves from another part of the body, such as from the heart to the

neck or brain

 Stenosis: when a blood vessel in the brain narrows, typically due to fatty deposits lining

the walls of the artery

b. Hemorrhagic stroke: This is the second major kind of stroke. It’s marked by a burst

blood vessel that causes blood to leak into or around the brain. This break reduces

delivery of oxygen and nutrients to brain cells and exposes the brain tissue to toxic

substances that may cause the cells to die. The bleeding also increases pressure inside the

skull that can compress brain tissue and cause damage.

Lower your risk of stroke

Some risk factors for stroke, such as age, race and ethnicity, and family history, can’t be

controlled. But there are steps you can take to help lower your risk, including:

 Control high blood pressure. Regularly check your blood pressure. If it is high, follow

a doctor’s advice on how to lower it. Treating high blood pressure lowers the risk of

both stroke and heart disease.

 Don’t smoke. Smoking increases your risk for stroke. It’s never too late to quit.

 Control your cholesterol. High blood cholesterol levels can lead to plaque buildup in

your arteries. In time, this can block blood flow and lead to a stroke. If you have high

cholesterol, work with a doctor to lower it.

 Control your diabetes. Untreated diabetes can damage blood vessels and lead to

narrowed arteries and stroke. Follow a doctor’s suggestions for keeping diabetes

under control.

 Eat healthy foods. Eat foods that are low in cholesterol and saturated fats. Include a

variety of fruits and vegetables every day.

 Exercise regularly. Try to make physical activity a part of your everyday life. Do

things you like; for example, take a brisk walk, ride a bicycle, or go swimming. Talk

with your health care provider if you haven’t been exercising and you want to start an

exercise program or increase your physical activity.

 Manage blood thinners. Too much blood thinning medication, such as aspirin or

anticoagulants, can lead to bleeding. If you take these medications, a doctor can help

to ensure your dosage is correct.

Treatment depends on the type of stroke and may include medications, surgery, other procedures,

and rehabilitation.

a. Ischemic stroke treatments: Drug therapy is the most common treatment for strokes

caused by a blood clot. The two most common drug therapies for stroke are:

 Antithrombotics, which prevent the formation of new blood clots that can become

stuck in an artery of the brain and cause strokes. This group of drugs includes

antiplatelet and anticoagulant drugs, also called blood thinners. They help stop

cells and other factors in the blood from sticking together and forming blood

clots.

 Thrombolytics, which treat the stroke by dissolving the blood clot that is blocking

blood flow to the brain. The most commonly used drug for thrombolytic therapy

is called tissue-plasminogen activator (t-PA), but other drugs can do the same

thing. Starting treatment with t-PA within three hours after an ischemic stroke is

important for recovery. Getting to a hospital right away allows time for a CT scan

of the brain, which helps the doctor decide whether the clot-busting medicine is

the right treatment choice.

b. Hemorrhagic stroke treatments: Treatment for hemorrhagic stroke involves finding the

source of the bleeding and controlling it. Hemorrhagic strokes get worse with

thrombolytic medications, so it is essential to determine the type of stroke before starting

emergency treatment. Hemorrhagic strokes require surgery or other procedures to stop

the bleeding and relieve any pressure on the brain caused by the excess fluids. Surgery

and vascular procedures are also often used to prevent stroke, reduce the risk of having
 another stroke, or repair damage to the arteries or malformations in and around the brain.

These include:

 Angioplasty: The insertion and inflation of a small balloon within a blocked artery

to press plaque or a blood clot against the artery wall to improve blood flow.

 Stenting: The placement of a small metal tunnel, or stent, in the clogged artery.

The stent helps to keep the artery open and decrease the chance of it narrowing

again.

 Carotid endarterectomy: A surgical procedure in which a doctor removes fatty

deposits blocking one of the two carotid arteries, the main suppliers of blood for

the brain.

 Endovascular thrombectomy: The removal of a large clot using a special device

that can suction out or grab a clot and pull it out.

Rehabilitation from stroke

There are many different ways to help people get better after a stroke. Many treatments start in

the hospital and continue at home. By supporting the brain’s ability to rewire some of the circuits

lost after a stroke — a process called neuroplasticity — rehabilitation therapy may lead to some

improved function over months or years.

 Physical therapy: Helps a person relearn simple motor activities such as walking, sitting,

standing, lying down, and the process of switching from one type of movement to

another.

 Occupational therapy: Helps a person relearn everyday activities, such as eating,

drinking, and swallowing; bathing and dressing; cooking; reading and writing; and using
 the toilet. Using exercise and training activities, occupational therapists focus on helping

a person become independent or semi-independent.

 Speech therapy: Helps a person relearn language and speaking skills or learn other forms

of communication. With time and patience, a stroke survivor may be able to regain some,

and sometimes all, language and speaking abilities.

I. PATIENT’S PROFILE

Name: T. D.

Age: 74 y/o

Gender: Male

Provider of History: Son

Address: Magabta, Kabugao, Apayao

Place of Birth: Magabta, Kabugao, Apayao

Date of Birth: June 06, 1948

Nationality: Filipino

Civil Status: Married

Educational Attainment: Elementary Graduate (Grade 6)

Religion: Roman Catholic

Language: Isnag, Tagalog

Occupation: N/A

Weight (current): 58 kg

Height: 167 cm

Body Mass Index: 20.86 (Healthy)

Date and Time of Admission: August 24, 2022, 12:23 P.M.

Date Handled: August 30, 2022, 7am-7pm

Reason for Admission: Right-sided body weakness

Medical Diagnosis: T/C Re-Stroke

Attending Physician: Dr. G. Ramos

II. PATIENT’S HEALTH HISTORY
a) Reason for Admission
Client T.D. was brought to the Emergency Department of St. Paul Hospital
Tuguegarao on August 24, 2022 12:23PM due to right-sided body weakness as his
chief complain and latest blood pressure of 170/120mmhg.

b.) History of Present Illness

Upon assessment in the Emergency Department, there is a sudden onset of facial
asymmetry, he also presented headache, dizziness, episodes of nausea and vomiting and
right- sided body weakness. His level of consciousness is GCS 11 and initial vital signs were
taken by the ER nurse with BP 170/120 mmHg, HR 82 bpm, RR 22 bpm, and T 36.5 C.
Nicardipine Drip were started at 30 ugtts/min and Mannitol 100ml given at the referring
hospital. Laboratory extractions facilitated by med tech on duty. He was then diagnosed
with Re Stroke, CVD Infarct.

c.) Past Health History

The significant other stated that he is not aware with regards to the immunization
status of client T.D. In addition, he also mentioned that the client is not vaccinated for
COVID-19 vaccines. When it comes to his childhood illnesses, the significant other recalled
that his father do not have any diagnosed underlying illnesses. In terms of allergies, the
significant other stated that client T.D. has no known allergies on food and medications,
thus, the only allergy he had was hair coloring. He said that client T.D. experienced it last
2016 where he was then hospitalized because of swollen eyes and itchy skin.
With regards to surgeries and hospitalization, client T.D. was diagnosed with Heart
Failure on 1990s by Dr. Ramos, he undergone surgery on his gallbladder last 2010 at St.
Paul Hospital together with his 4th attack. According to his significant other, the main reason
of the client’s hospitalization was his recurrent stroke attack. The client’s first attack was last
2008, his fourth attack was last 2010, the fifth attack was last 2018 and his seventh attack
was last November 2021. Thereafter, the client undergone physical therapy last February
2022. In terms of accidents and injuries, the significant other stated that client T.D. had no
history of accidents and inju
 NURSING CARE PLAN

ASSESSMENT NURSING GOALS INTERVENTIONS AND RATIONALE EVALUATION

DIAGNOSIS OF CARE

Objective data: Ineffective The patient 1. Positioned the patient by maintaining on high After 12 hours of nursing
airway will able to back rest. (Upright position limits abdominal contents management, the patient was
- Noted with clearance expectorate from pushing upward and inhibiting lung expansion. able to expectorate secretions
productive related to secretions This position promotes better lung expansion and as manifested by absence of
cough retained as improved air exchange.) crackles
secretions manifested
- presence of 2. Explained the importance of deep breathing and
secondary to by absence
crackles upon coughing exercises. (Performing respiratory exercise
neuromuscular of crackles
auscultation of will help prevent respiratory system complications.)
involvement
breath sounds
3. Facilitated chest physiotherapy. (To facilitate
- With oxygen removal of retained or profuse airway secretions.)
support at
2LPM via nasal 4. Suctioned secretions as needed. (Suctioning is
cannula needed when patients are unable to cough out
secretions properly due to weakness, thick mucus
- Right-sided plugs, or excessive or tenacious mucus production.)
body weakness
5. Maintained oxygen support as prescribed,
2LPM/nasal cannula. (Increasing humidity of
inspired air will reduce thickness of secretions and aid
their removal.)
 ASSESSMENT NURSING GOALS OF INTERVENTIONS AND RATIONALE EVALUATION
DIAGNOSIS CARE
Objective: Risk for The patient 1. Assessed level of consciousness. (The primary risk After 12 hours of
-With NGT for OF Aspiration will avoid any factor of aspiration is decreased level of consciousness.) nursing intervention the
feeding related to signs of patient observed no
-Difficulty decreased aspiration as 2. Positioned patient to Fowler’s position when signs of aspiration as
swallowing ability to observed by feeding. (To prevent food/ liquid to be aspirated into observed with no
-GCS 10/15 (awake swallow unlabored the airway and lungs.) presence of unlabored
to drowsy) secondary to breathing and breathing, no episode of
stroke oxygen 3. Checked patency of NGT before feeding, using shortness of breath and
saturation auscultation, x-ray study (most accurate), and with 99% oxygen
within normal gastric aspirate. (A displaced tube may erroneously saturation noted..
limit deliver tube feeding into the airway. Chest x-ray
verification of accurate tube placement is most reliable.
Gastric aspirate is usually green, brown, clear, or
colorless.)

4. Checked residuals before feeding, or every 4

hours if feeding is continuous or tolerated. (Large
amounts of residuals indicate delayed gastric emptying
and can cause distention of the stomach, leading to
reflux emesis.)

5. Kept suction machine at the bedside. (Patients at

an increased risk for aspirating should have functioning
suctioning equipment at the bedside for immediate use.)

ASSESSMENT NURSING GOALS OF INTERVENTIONS AND RATIONALE EVALUATION

DIAGNOSIS CARE
Objective: Impaired The patient will 1.Assisted patient reposition self on a regular After 12 hours of
- Right hemiplegia Physical be free from schedule. (To promote optimal level of function and nursing intervention, the
- Limited range of Mobility complications of prevent complications such as pressure ulcer) patient has no signs of
motion related to immobility, as severity of blister and
- Presence of blister at neuromuscular evidenced by no 2. Provided a safe environment, bed rails up, bed was able to participate
right inner thigh involvement signs of severity in a down position, important items close by like in passive ROM.
- Muscle strength secondary to of blister, and wheelchair. (These measures promote a safe,
Right arm: 0/5 CVA infarct able to secure environment and may reduce risk for falls)
Right leg: 0/5 participate in
Left arm: 3/5 (active passive ROM. 3. Executed passive or active assistive ROM
movement against exercises to all extremities. (Exercise enhances
gravity) increased venous return, prevents stiffness, and
Left leg: 3/5 (active maintains muscle strength and stamina.)
movement against
gravity) 4. Provided egg crate mattress as necessary. (The
equipment decrease pressure on skin or tissues that
can damage circulation, potentiating risk of tissue
ischemia or breakdown and decubitus formation.)

DRUG STUDY
DRUG NAME THERAPEUTIC OF INDICATIONS ADVERSE PRECAUTIONS NURSING CONSIDERATIONS
ACTIONS EFFECTS
Generic Inhibits the movement of  Angina pectoris  CNS:  Contraindicat Assessment 
Name:  calcium ions across the due to coronary Dizziness, ed with  History: Allergy to amlodipine, impaired
AMLODIPINE membranes of cardiac and artery spasm light- allergy to hepatic or renal function, lactation, CHF
  arterial muscle cells; inhibits (Prinzmetal’s headedness, amlodipine,  Physical: Skin lesions, color, edema; P, BP,
variant angina) fatigue impaired baseline ECG, auscultation; R, adventitious
Brand Name: transmembrane calcium
 Chronic stable  CV: hepatic or sounds; liver evaluation, GI normal output;
Norvasc flow, which result in the angina, alone or Peripheral renal function, renal function tests, urinalysis
depression of impulse in combination Edema lactation Interventions 
Classification: formation in specialized with other drugs  Dermatologi  Use  WARNING: Monitor patient carefully (BP,
 Calcium cardiac pacemaker cells,  Essential c: Flushing, cautiously cardiac rhythm, and output) while adjusting
channel- slowing of the velocity of hypertension, rash with CHF, drug to therapeutic dose; use special caution if
conduction of the cardiac alone or in  GI: Nausea, pregnancy patient has CHF.
blocker,
combination with abdominal    Monitor BP very carefully if patient is also
Antianginal, impulse, depression of the
other discomfort on nitrates.
Antihypertensiv myocardial contractility, and antihypertensives
e dilation of the coronary  Monitor cardiac rhythm regularly during
stabilization of dosage and periodically during
arteries and arterioles; these
long-term therapy.
Pregnancy effects lead to decreased
  Administer drug without regard to meals.
Category C  cardiac work, decrease Teaching points  
cardiac oxygen  Take with meals if upset stomach occurs.
Patient’s consumption, and in patients  You may experience these side effects:
Dose/Route: with vasospastic Nausea, vomiting (eat frequent small meals);
5mg tab OD (Prinzmental’s) angina, headache (adjust lighting, noise, and
increase delivery of oxygen temperature; medication may be ordered).
to cardiac cells.  Report irregular heartbeat, shortness of breath,
swelling of the hands or feet, pronounced
dizziness, constipation.
 

Drug Details Mechanism of Action Indications and Side Effects and Nursing Responsibility
Contraindications Adverse
Reactions
Generic Name: Indications: Atorvastatin Adverse Effect:  Stress that atorvastatin is an
Atorvastatin  Reduction of risk of stroke competitively inhibits Headache, adjunct to – not a substitute for
and heart attack in type 2 HMG-CoA reductase, flatulence, low-cholesterol diet
Brand Name: diabetes patients without the enzyme that diarrhoea, nausea,  Tell patient to take drug at the
lipitor evidence of heart disease but catalyses the vomiting, same time each day to maintain
with other CV risk factors, conversion of HMG- anorexia, its effects
Classification: and revascularization CoA to mevalonic xerostomia,  Instruct patient to take a missed
Dyslipidaemic procedures in patients acid. This results in the angioedema, dose as soon as possible. If it’s
Agent without evidence of coronary induction of the LDL myalgia, almost time for his next dose, he
heart disease (CHD) but with receptors, leading to rash/pruritus, should skip the missed dose.
Dosage: multiple risk factors other lowered LDL- alopecia, allergy,  Advise patient to notify
20mg than diabetes (eg, smoking, cholesterol infection, chest prescriber immediately if he
HTN, low HDL-C, family concentration. pain.  develops unexplained muscle
Frequency: history of early CHD) Absorption: Rapid pain, tenderness, or weakness,
Once daily  Patients with CHD, to reduce from the GI tract Potentially especially if accompanied by
2000H risks of MI, revascularization (oral). Fatal: Thromboc fatigue or fever
procedures, hospitalization Distribution: Protein- ytopenia.
Route: for CHF, and angina binding: 98%. Rhabdomyolysis
G-tube Metabolism: Extensiv with acute renal
Contraindication: ely hepatic; converted failure.
Date ordered: Hypersensitivity, active liver to active inhibitors of
March 19, 2014 disease or unexplained HMG-CoA reductase.
persistent elevations of serum Excretion: Faeces (as
transaminase, porphyria, metabolites); 14 hr
pregnancy, lactation. (elimination half-life).

Drug Details Mechanism of Indications and Contraindications Side Effects and Nursing Responsibility
Action Adverse Reactions
Generic Name: Competitively inhibits Indication: Activates the biosynthesis of Adverse Reaction: Instruct patient to take
Citicoline the action of structural phospholipids in neuronal Gastrointestinal the medication as
Brand: histamine at H2 membrane, increase cerebral metabolism and disorders, itching, prescribed. Teach the
Zynapse receptors of the increase the level of various neurotransmitter, hives, swelling in patient that citicoline may
parietal cells of the including acetylcholine and dopamine. face or hands, be taken with or without
Classification: stomach inhibiting Citicoline has shown neuroprotective effects vomiting and food. Monitor for adverse
Neuroprotectiv basal gastric acid in situations hypoxia and ischemia diarrhea, slow or fast effects; instruct patient to
e secretion and gastric heartbeat report immediately if
CNS drugs and acid secretion that is Contraindication: he/she develops chest
agent for stimulated by food Allergy References: tightness, tingling in mouth
ADHD insulin, histamine, This medicine is not recommended for use if www.mims.com and throat, headache,
Dosage: 1g cholinergic agonists, you have a known history of allergy to diarrhea and blurring of
gastrin and Citicoline or any other ingredients present vision.
Route: pentagastrin. along with it.
Intravenous Hypertonia References:
References: This medicine is not recommended for use www.mims.com
Frequency: www.mims.com in patient having abnormal muscle tension
Every 8hrs and stiffness due to nerve damage in the
brain. This condition is also present in
Duration: people who have had a brain surgery to
Continuous remove certain specific nerves.
until MD Pediatric Use
This medicine is not recommended for use
advise
in children who are aged 18 or below.

References:
www.mims.com
Drug Details Mechanism of Indications and Side Effects and Adverse Nursing Responsibility
Action Contraindications Reactions
Generic Name: Omeprazole Indication: CNS: Agitation, asthenia, Give omeprazole before meals, preferably
Omeprazole interferes with To treat symptomatic dizziness, drowsiness, fatigue, in the morning for once-daily dosing. If
gastric acid gastroesophageal fever, headache, malaise, psychic needed, also give an antacid, as prescribed.
Brand: Prosec secretion by reflux disease disturbance, somnolence CV: If needed, open capsule and sprinkle
inhibiting the (GERD) Chest pain, hypertension, enteric-coated granules on applesauce or
Classification: hydrogen peripheral edema EENT: Anterior yogurt or mix with water or acidic fruit
Proton pump potassium Contraindication ischemic optic neuropathy, optic juice, such as apple or cranberry juice.
inhibitor adenosine Concurrent therapy atrophy or neuritis, otitis media, Give immediately. Give drug via NG tube,
triphosphatase with rilpivirine- stomatitis ENDO: Hypoglycemia when needed by mixing granules in acidic
Dosage: (H+ K+ - containing products; GI: Abdominal pain, acid juice, because enteric coating dissolves in
Adults: 20 mg ATPase) hypersensitivity to regurgitation, constipation, alkaline pH, or using the delayed-release
daily enzyme system, omeprazole, diarrhea, Clostridium difficile- oral suspension form by mixing with water.
or proton pump, substituted associated diarrhea, dyspepsia, Know that because drug can interfere with
Route: Oral in gastric benzimidazoles, or elevated liver enzymes, flatulence, absorption of vitamin B12, monitor patient
parietal cells. their components. fundic gland polyps (long-term for macrocytic anemia. Monitor patient for
Frequency: use), hepatic dysfunction or failure, bone fracture, especially in patients
Twice a day References: References: indigestion, nausea, pancreatitis, receiving multiple daily doses for more
20TH Edition 20TH Edition Nurse vomiting than a year because proton pump inhibitors,
Duration: Nurse Drug Drug Handbook such as omeprazole, increase risk for
Continuous as Handbook By JONES AND References: osteoporosis-related fractures of the hip,
MD advise. By JONES BARTLETT 20TH Edition Nurse Drug spine, or wrist.
AND Learning 2021 Handbook
BARTLETT By JONES AND BARTLETT References:
Learning 2021 Learning 2021 20TH Edition Nurse Drug Handbook
By JONES AND BARTLETT Learning
2021

Drug Details Mechanism of Indications and Side Effects and Adverse Reactions Nursing Responsibility
Action Contraindications
Generic: Elevates plasma Indication: CNS: Asthenia, chills, coma, Assess patient for hypersensitivity
Mannitol osmolality, causing To reduce intracranial or confusion, dizziness, fever, reactions, including anaphylaxis,
Brand: water to flow from intraocular pressure headache, lethargy, malaise, rebound dyspnea, and hypotension; cardiac
Classification tissues, such as increased intracranial pressure, arrest and death have occurred. If
: Osmotic brain and eyes, and Contraindication: seizures CV: Chest pain, heart hypersensitivity reactions present,
Diuretic from CSF, into Active intracranial failure, hypertension, hypotension, stop infusion immediately, notify
extracellular fluid, bleeding (except during palpitations, peripheral edema, prescriber, and expect to provide
Dosage: thereby decreasing craniotomy), anuria, tachycardia, thrombophlebitis EENT: supportive emergency care.
100 ml intracranial and hypersensitivity to Blurred vision, dry mouth, rhinitis
intraocular pressure. mannitol or its GI: Diarrhea, nausea, vomiting GU: Monitor patient, especially patient
Route: IV As an osmotic components, severe Acute kidney injury, anuria, with impaired renal function, for
Frequency: diuretic, mannitol pulmonary vascular azotemia, hematuria, oliguria, CNS toxicity such as coma,
Every 6 hours increases the congestion or osmotic nephrosis, polyuria, urine confusion, or lethargy. This may
osmolarity of pulmonary edema, retention. occur as a result of high serum
Duration: glomerular filtrate, severe hypovolemia. mannitol concentrations or
Continuous as which decreases References: disturbances of electrolyte and
MD advise water reabsorption. References: 20TH Edition Nurse Drug Handbook acid–base balance caused by
20TH Edition Nurse By JONES AND BARTLETT mannitol administration.
References: Drug Handbook Learning 2021
20TH Edition Nurse By JONES AND References:
Drug Handbook BARTLETT Learning 20TH Edition Nurse Drug
By JONES AND 2021 Handbook
BARTLETT By JONES AND BARTLETT
Learning 2021 Learning 2021

Drug Details Mechanism of Indications and Side Effects and Adverse Nursing Responsibility
Action Contraindications Reactions
Generic Name: Antagonizes the Indication: To treat CNS: Agitation, anxiety, Watch closely for tardive dyskinesia, especially
Metoclopramide inhibitory effect gastroesophageal confusion, depression, in the elderly, women, and patients with diabetes,
Brand: of dopamine on reflux disease dizziness, drowsiness, because this serious adverse effect is often
Classification: GI smooth extrapyramidal reactions irreversible even after therapy stops.
Dopamine 2 muscle. This Contraindication: (motor restlessness,
receptor causes gastric Catecholamine- Parkinsonism, tardive Monitor patient closely for neuroleptic malignant
antagonist contraction, releasing dyskinesia), fatigue, syndrome, a rare but potentially fatal disorder
which promotes paragangliomas, hallucinations, headache, characterized by hyperthermia, muscle rigidity,
Dosage: gastric emptying epilepsy, history of insomnia, irritability, altered level of consciousness, irregular pulse or
10 mg and peristalsis, dystonic reaction or lassitude, panic reaction, blood pressure, tachycardia, diaphoresis, and
Route: Oral thus reducing tardive dyskinesia restlessness, seizures, arrhythmias.
Frequency: gastroesophageal to metoclopramide, suicidal ideation CV: AV
Thrice a day reflux. hypersensitivity to block, bradycardia, fluid Know that risk increases in patients experiencing
metoclopramide or retention, heart failure, a toxic reaction to metoclopramide as a result of
Duration: References: its components. hypertension, hypotension, overdosage or receiving concomitant treatment
Continuous as 20TH Edition supraventricular tachycardia. with another drug associated with neuroleptic
MD advise Nurse Drug References: malignant syndrome. Expect metoclopramide to
Handbook 20TH Edition Nurse References: be discontinued immediately, if present.
By JONES AND Drug Handbook 20TH Edition Nurse Drug
BARTLETT By JONES AND Handbook References:
Learning 2021 BARTLETT By JONES AND 20TH Edition Nurse Drug Handbook
Learning 2021 BARTLETT Learning 2021 By JONES AND BARTLETT Learning 2021

Drug Details Mechanism of Action Indications and Side Effects and Nursing Responsibility
Contraindications Adverse Reactions
Generic Name: Ampicillin inhibits Indication: Treatment of SE: Before drug Administration:
Sultamicillin bacteria cell wall susceptible infections, CNS: Dizziness, Baseline Assessment; Ask patient for
Brand: Unasyn synthesis. Sulbactam including intra-abdominal, Somnolence, Sedation, history of penicillin allergy
Classification: inhibits bacterial gynecologic infections, due Headache During Administration:
Penicillin betalactamase. to beta-lactamase Respiratory: Dyspnea PO
Dosage: producing organisms Immune System: The interacting penicillin should be
750 mg References: including H. Influenzae,E Anaphylactic Shock, administered one hour before or two
Route: Oral www.studocu.com coli,Klebsiella, Hypersensitivity. hours after meals.
Frequency: Acinetobacter, After Drug Given:
Duration: Enterobacter, S. aureus and References: Intervention/Evaluation
Continuous as bacteroides spp. www.studocu.com >Hold medication and promptly report
MD advise. rash or diarrhea
Contraindication: >Monitor I and O, UA, renal function
Hypersensitivity to any tests.
penicillinor sulbactam. >Be alert for superinfection: fever,
vomiting, diarrhea, anal, / genital
References: pruritus, oral mucosal changes
www.studocu.com (ulceration, pain, erythema).
References:
www.studocu.com

Name of Classification Mechanism Indication Contraindications Side Effects Nursing Responsibilities

Drug of Drug of Action
Generic Therapeutic: Inhibits Treatment Contraindicated CNS: Headache, History: Allergy to clopidogrel,
Name: Adenosine dip platelet of patients with allergy dizziness, weakne pregnancy, lactation, bleeding
clopidogrel hosphate (AD aggregation at risk for to clopidogrel, ss, syncope, disorders, recent surgery, hepatic
Trade P) receptor by blocking ischemic active pathological flushing impairment, peptic ulcer
Name: antagonist ADP events— bleeding such as CV: Hypertensio Provide small, frequent meals if GI
 Plavix receptors on history of peptic ulcer or n, edema upset occurs (not as common as
platelets, MI, intracranial Dermatologic: R with aspirin).
Antiplatelet preventing ischemic hemorrhage, ash, pruritus
Availability: Provide comfort measures and
Tablets—75  clumping of stroke, lactation. GI: Nausea, GI arrange for analgesics if headache
mg Pregnancy platelets. peripheral distress, occurs.
Category B artery constipation,
disease Use cautiously with diarrhea, GI bleed Take daily as prescribed. May be
bleeding disorders, Other: Increased taken with meals.
Treatment recent surgery, bleeding risk may experience these side effects:
of patients hepatic impairment, Dizziness, light-headedness (this
with acute pregnancy. may pass as you adjust to the drug);
coronary headache (lie down in a cool
syndrome environment and rest; OTC
preparations may help); nausea,
gastric distress (eat frequent small
meals); prolonged bleeding (alert
doctors, dentists of this drug use).
Report skin rash, chest pain,
fainting, severe headache, abnormal
bleeding.
 Predisposing Precipitating Factors
Factors - Sedentary lifestyle
Concept Map on
- Age: 74 years old - Unhealthy diet
- Family History of Recurrent Stroke
- Diagnosed with CHF
Hypertension
- History of 7 attacks (stroke)

Foam cells accumulate to form plaque Increased in HDL as

evident on patient’s Lipid
profile result 08/24/22

Fibrous cap covers the area

Signs and symptoms
- Headache; nape pain
Blood pressure increases - Dizziness; easy fatiguability
- Nausea and/or vomiting

Release of plaque into the bloodstream

Nursing diagnosis &
management
Impaired Tissue Plaque goes into the systemic circulation
perfusion related to
blood pressure
elevation Plaque enters into the blood vessels of the brain Signs and symptoms
- Monitor blood - Shortness of breath
pressure - Sudden change in
- Assess patient Blood vessels becomes narrowed by plaque level of consciousness:
condition GCS 10-11/15
- Hooked patient to
O2 inhalation at 2LPM Decreased oxygen delivery to the brain

Evident in CT scan and CXR

Continuous accumulation of plaque in the blood vessels result done last 08/24/22

Signs & Symptoms

Collateral circulation is blocked -Right-sided hemiplegia
-muscle weakness; trouble walking

Nursing diagnosis & Management

Blood vessels compensate and blood Ischemic stroke Impaired physical mobility related to stroke
is delivered into circle of Willis - Massage affected area to increase circulation
- Collaborate with Physical Therapist

Increased intracranial
Blood and oxygen are delivered pressure Mannitol 20%
into some parts of the brain 100cc IVTT q 6
Endothelial cells dysfunction
hours
 Signs &
Nursing Dx & Management Hypoxia of brain cells Symptoms
Impaired verbal -Numbness or Patient with
in premembral zone
communication related to weakness IFC
alterations of the brain -Loss of connected
functions coordination to urine bag
Damage to the
-Collaborate to speech
anterior or middle
therapist
-Use strategies to improve cerebral artery
Signs & Symptoms
client’s comprehension by Patient
-Sudden loss of
using touch and behavior to verbal output with
communicate calmness and Damage to the -Unable to swallow NGT
non-verbal communication Broca’s area voluntarily

Nursing diagnosis
Imbalanced Nutrition: Less than body
Treatment medications: requirements related to difficulty in swallowing
-Citicoline IVTT q 12h secondary to neurological disorder and damage
-Amlodipine 10mg tab OD
-Clopidogrel tab OD
-Atorvastatin 40mg tab OD Good prognosis Poor prognosis
-Metoclopramide tab BID (Continued medical treatment) (Continued medical
-Sultamicillin 750mg tab TID treatment)

Increased oxygen delivery to the

brain Patient is still with no signs
of improvement

Blood clot/ plaque dissolved/

removed Brain tissue necrosis

Treatment:
-Continue medication Oxygen and nutrients enter the Irreversible brain damage
-Start rehabilitation brain cells
process
DEATH
RECOVERY